Nutritional Course of Patients Submitted to Bariatric Surgery

Background Surgical treatment has proved to be effective for weight loss, improving the quality of life of obese individuals. However, metabolic and nutritional deficiencies may occur during the late postoperative period. The objective of the present study was to assess the metabolic and nutritional profile of grade III obese individuals for 12 months after Roux-en-Y gastric bypass (RYGBP). Methods Forty-eight patients with mean body mass index (BMI) of 51.9 +/- 7.8 kg/m(2) were submitted to RYGBP. Anthropometric, food intake, and biochemical data were obtained before and for 12 months after surgery. Results There was an average weight and body fat reduction of 35% and 46%, respectively. Calorie intake was reduced, ranging from 773 +/- 206 to 1035 +/- 345 kcal during the study. Protein intake remained below recommended values throughout follow-up, corresponding to 0.5 +/- 0.3 g/kg/current body weight/day during the 12th month. Iron and fiber intake was significantly reduced, remaining below recommended levels throughout the study. Serum cholesterol, low-density lipoprotein cholesterol, and glycemia were reduced. Albumin deficiency was present in 15.6% of subjects at the beginning of the study vs 8.9% at the end, calcium deficiency was present in 3.4% vs 16.7%, and iron deficiency was present in 12.2% vs 14.6%. Conclusions RYGBP was effective for weight loss and for the reduction of obesity rates and risk factors for comorbidities. The diet of these patients, who frequently present inadequate intake of macronutrients and micronutrients, should receive special attention. Patient follow-up and assessment at short intervals are necessary for an early correction of nutritional deficiencies.

Change in Predicted 10-Year Cardiovascular Risk Following Roux-en-Y Gastric Bypass Surgery: Who Benefits?

The risk of developing cardiovascular disease is higher in obese than in non-obese individuals. Surgery for obesity is effective in reducing weight and resolution of diabetes, hypertension, and dyslipidemia. Our aim was to assess the estimated 10-year cardiovascular risk of obese patients before and after treatment of obesity with a gastric bypass. Weight, body mass index systolic and diastolic blood pressure, lipid profile, glycemia, and history of cardiovascular disease were obtained for obese patients before and 2 years after Roux-en-Y gastric bypass surgery. Ten-year cardiovascular risk was calculated using the Framingham score. Forty-two patients were included in the study. We observed a significant reduction (p < 0.05) of 10-year cardiovascular risk mainly associated with weight reduction and improvement of comorbidities associated with obesity. The benefits were greater among patients who already presented known risk factors such as diabetes and hypertension. Superobese patients benefited as early as 2 years after surgery, when weight loss was greater. Weight loss secondary to surgery was sustained after 2 years and promoted improvement of comorbidities, with an important reduction of 10-year cardiovascular risk especially among patients with previous risk factors.

Intracultural Diversity in Food Knowledge in Southern Brazil

This research explores the social distribution of food knowledge in Ribeirao Preto, a city in the state of Sao Paulo, Brazil. Through an analysis of the distribution of individual expertise in regard to the cultural model of food along the dimensions of healthfulness, practicality, and prestige, this research demonstrates that knowledge of the cultural model of food is most strongly shared in the upper class of the city. Qualitative and quantitative ethnographic research suggests that the social patterning of health-related food knowledge in Ribeirao Preto may serve to maintain class distinction.

Cultural Consonance, a 5HT2A Receptor Polymorphism, and Depressive Symptoms: A Longitudinal Study of Gene x Culture Interaction in Urban Brazil

In this study in urban Brazil we examine, as a predictor of depressive symptoms, the interaction between a single nucleotide polymorphism in the 2A receptor in the serotonin system (-1438G/A) and cultural consonance in family life, a measure of the degree to which an individual perceives her family as corresponding to a widely shared cultural model of the prototypical family. A community sample of 144 adults was followed over a 2-year-period. Cultural consonance in family life was assessed by linking individuals` perceptions of their own families with a shared cultural model of the family derived from cultural consensus analysis. The -1438G/A polymorphism in the 2A serotonin receptor was genotyped using a standard protocol for DNA extracted from leukocytes. Covariates included age, sex, socioeconomic status, and stressful life events. Cultural consonance in family life was prospectively associated with depressive symptoms. In addition, the interaction between genotype and cultural consonance in family life was significant. For individuals with the A/A variant of the -1438G/A polymorphism of the 2A receptor gene, the effect of cultural consonance in family life on depressive symptoms over a 2-year-period was larger (beta = -0.533, P < 0.01) than those effects for individuals with either the G/A (beta = -0.280, P < 0.10) or G/G (beta = -0.272, P < 0.05) variants. These results are consistent with a process in which genotype moderates the effects of culturally meaningful social experience on depressive symptoms. Am. J. Hum. Biol. 21:91-97, 2009. (C) 2008 Wiley-Liss, Inc.

Cultural consonance and adult body composition in urban Brazil

In previous research in Brazil, we found socioeconomic and gender differences in body mass and percent body fat, consistent with a model in which individuals in higher socioeconomic strata, especially women, could achieve a cultural ideal of body size and shape. In this article, using new data, we examine these processes more precisely using measures of cultural consonance. Cultural consonance refers to the degree to which individuals approximate, in their own beliefs and behaviors, the shared prototypes for belief and behavior encoded in cultural models. We have found higher cultural consonance in several domains to be associated with health outcomes. Furthermore, there tends to be a general consistency in cultural consonance across domains. Here we suggest that measures of body composition can be considered indicators of individuals` success in achieving cultural ideals of the body, and that cultural consonance in several domains will be associated with body composition. Using waist circumference as an outcome, smaller waist size was associated with higher cultural consonance in lifestyle (beta = -0.311, P < 0.01) and higher cultural consonance in the consumption of high prestige foods (beta = -0.260, P < 0.01) for women (n = 161), but not for men (n = 106), controlling for age, family income, tobacco use, and dietary intake of protein and carbohydrates. Similar results were obtained using the body mass index and weight as outcomes, while there were no associations with height. These results help to illuminate the cultural mediation of body composition.

An evaluation of the genotoxic and cytotoxic effects of the anti-obesity drugs sibutramine and fenproporex

Anti-obesity medications deserve special considerations at the present time due to an increasing number of overweight and obese people who require these therapeutic alternatives. Obesity is positively associated with several chronic illnesses, including cancer. In this work, we evaluated the possible genotoxic and/or cytotoxic actions of two drugs, sibutramine and fenproporex, in the doses of 10, 20 and 40 mg/kg body weight (bw), administered intraperitoneally in male Swiss mice. The genotoxic effect was analyzed by comet assay and micronucleus test. We found that both drugs increased the frequency of genotoxic damage in Swiss mice, but did not present cytotoxic activities towards the polychromatic erythrocytes of the bone marrow of these animals.

Vascular proinflammatory responses by aldosterone are mediated via c-Src trafficking to cholesterol-rich microdomains: role of PDGFR

Aims We demonstrated c-Src activation as a novel non-genomic signalling pathway for aldosterone in vascular smooth muscle cells (VSMCs). Here, we investigated molecular mechanisms and biological responses of this phenomenon, focusing on the role of lipid rafts/caveolae and platelet-derived growth factor receptor (PDGFR) in c-Src-regulated proinflammatory responses by aldosterone. Methods and results Studies were performed in cultured VSMCs from Wistar-Kyoto (WKY) rats and caveolin-1 knockout (Cav 1(-/-)) and wild-type mice. Aldosterone stimulation increased c-Src phosphorylation and trafficking to lipid rafts/caveolae. Cholesterol depletion with methyl-beta-cyclodextrin abrogated aldosterone-induced phosphorylation of c-Src and its target, Pyk2. Aldosterone effects were recovered by cholesterol reload. Aldosterone-induced c-Src and cortactin phosphorylation was reduced in caveolin-1-silenced and Cav 1(-/-) VSMCs. PDGFR is phosphorylated by aldosterone within cholesterol-rich fractions of VSMCs. AG1296, a PDGFR inhibitor, prevented c-Src phosphorylation and translocation to cholesterol-rich fractions. Aldosterone induced an increase in adhesion molecule protein content and promoted monocyte adhesion to VSMCs, responses that were inhibited an by cholesterol depletion, caveolin-1 deficiency, AG1296 and PP2, a c-Src inhibitor. Mineralocorticoid receptor (MR) content in flotillin-2-rich fractions and co-immunoprecipitation with c-Src and PDGFR increased upon aldosterone stimulation, indicating MR-lipid raft/signalling association. Conclusion We demonstrate that aldosterone-mediated c-Src trafficking/activation and proinflammatory signalling involve lipid rafts/caveolae via PDGFR.

Visceral leishmaniasis and pregnancy: analysis of cases reported in a central-western region of Brazil

Objectives Because of the large number of cases of visceral leishmaniasis (VL) recorded in Brazil over the last few years, this disease has been showing characteristics different from previously known ones. We report cases of pregnant women treated for VL, describing their course and outcome and the chemotherapeutic medication used according to the clinical signs and symptoms of each patient. Study design We report five cases of pregnant women treated for VL in a central-western region of Brazil. Results No case of vertical transmission was observed, even in patients who were treated after delivery. One of the patients with a late diagnosis made after the onset of symptoms died. Thus, the treatment of VL during pregnancy reduces maternal mortality and the rate of vertical transmission of the disease, being safe and effective as long as the disease is diagnosed early. Conclusion At present, amphotericin B and its derivatives appear to be the best therapeutic option for the mother-child binomial.

Intestinal bacterial overgrowth after Roux-en-Y gastric bypass

The aim of the present study was to report the occurrence of serious subnutrition, associated to intestinal bacterial overgrowth, in two patients submitted to bariatric surgery. Two female patients (body mass index, 49 and 50 kg/m(2), respectively) were submitted to Y-en-Roux gastric bypass. The first patient evolved a 52% loss of body weight within 21 months after surgery; the other, a 34% loss of initial body weight within 15 months after surgery, results corresponding, respectively, to 62 and 45 kg weight losses. However, both patients reported asthenia, hair fallout, and edema, and one also reported diarrhea, but none was feverish. Their respective albuminemias were of 24 and 23 g/l. A respiratory hydrogen test suggested bacterial hyperproliferation. Thirty days after ciprofloxacin and tetracyclin treatments, they showed improved albumin levels and nutritional states, both confirmed by results of hydrogen breath tests. Bacterial overgrowth is an important complication that can compromise clinical evolution of patients submitted to intestinal surgery like gastroplasty with Y-Roux anastomosis. In cases of clinical suspicion or a confirmed diagnosis, adequate antibiotics, sometimes requiring to be cyclically repeated, should be administered.

Comparisons between bone and cementum compositions and the possible basis for their layered appearances

In humans, age estimation from the adult skeleton represents an attempt to determine chronological age based on growth and maturational events. In teeth, such events can be characterized by appositional growth layers in midroot cementum. The purpose of this study was to determine the underlying cause of the layered microstructure of human midroot cementum. Whether cementum growth layers are caused by changes in relative mineralization, collagen packing and/or orientation, or by variations in organic matrix apposition was investigated by subjecting midroot sections of human canine teeth to analysis using polarized light and scanning electron microscopy (SEM). Polarized light was used to examine transverse midroot sections in both mineralized and demineralized states. Mineralized sections were also reexamined following subsequent decollagenization. Polarized light was additionally used in the examination of mineralized sections taken transversely, longitudinally, and obliquely from the same tooth root. From the birefringence patterns it was concluded that collagen orientation does not change with varying section plane. Instead, the mineral phase was most responsible for the birefringence of the cementum. SEM studies suggested that neither collagen packing nor collagen orientation change across the width of the cementum, confirming and validating the results of the polarized light examination. Also, SEM analysis using electron backscatter and the electron probe suggested no changes in the mean atomic number density, calcium, phosphate, and sulfur levels across the width of the cementum. Therefore, we conclude that crystalline orientation and/or size is responsible for the layered appearance of cementum. (Bone 30:386-392; 2002) (C) 2002 by Elsevier Science Inc. All rights reserved.

Disciplina 4.2: planejamento estrat??gico governamental

Apresenta????o geral e discuss??o bibliogr??fica. Conceitos e tipos de planejamento. O pensamento complexo aplicado ?? gest??o governamental contempor??nea. O planejamento estrat??gico p??blico como ferramenta de implementa????o e gest??o de pol??ticas p??blicas. Os desafios e os atributos do planejamento governamental de longo prazo. Fun????es Cl??ssicas e Contempor??neas de Estado: arranjos institucionais-burocr??ticos, origem e perfil das pol??ticas p??blicas federais brasileiras. Planejamento Governamental e Gest??o P??blica no Brasil: hist??ria (s??culo XX) e contemporaneidade (s??culo XXI); Circuito Planejamento (formula????o, decis??o), Gest??o (monitoramento, desempenho, avalia????o), Controle (interno: m??todo CGU; externo: m??todo TCU), Participa????o (engajamento, avalia????o e controle social); Planejamento governamental e a estrat??gia de desenvolvimento brasileiro. A import??ncia da leitura dos atores para a viabilidade pol??tica da agenda governamental (Prof. A. Lassance): distin????o entre institui????es, organiza????es e atores; o que s??o os atores, como encontr??-los e como entender suas posi????es nos subsistemas de pol??ticas p??blicas; o poder de iniciativa, poder de agenda e agenda: tr??s coisas muito diferentes; m??todos para a leitura dos atores e an??lise da agenda pol??tica; t??cnicas, rotinas e sistem??ticas de varredura de temas e atores

Los desaf??os de las pol??ticas y la gesti??n social en Am??rica Latina

La pobreza est?? aumentando en t??rminos absolutos de manera sistem??tica desde 1990 y, desde comienzos del nuevo siglo, tambi??n en valores relativos. Hay, sin embargo, una buena nueva: el gasto p??blico social ha aumentado tambi??n de manera sistem??tica desde entonces. ??Qu?? se ha hecho con la enorme magnitud de recursos destinada a financiar las pol??ticas sociales? Hay, por un lado, limitaciones que surgen de la forma en que ellas se dise??an e implementan. La gesti??n social tradicional asume que el impacto perseguido se producir?? autom??ticamente como resultado de la mera entrega de los bienes o servicios a la poblaci??n destinataria. Aparece, adem??s, la masiva introducci??n de mecanismos de mercado en las pol??ticas sociales, bajo el supuesto que permitir??an mejorar su eficiencia e impacto. Teniendo en cuenta las limitaciones precedentes, se sugieren en este art??culo tres senderos, estos son: la superaci??n del estilo tradicional de gestionar los programas y proyectos sociales; el aprendizaje por medio de la experiencia de la evaluaci??n de impacto y del monitoreo; y la generaci??n de un estilo m??s participativo en el proceso de dise??o, gesti??n y evaluaci??n de las pol??ticas sociales.

Cursos abiertos en l??nea:?? un escenario para la gesti??n personal del conocimiento?

A partir de uma discuss??o dos antecedentes e caracter??sticas dos cursos on-line, este artigo descreve uma solu????o tecnol??gica de apoio ?? realiza????o deste tipo de curso, baseada no uso de ferramentas p??blicas e de uso gratuito(isto ??, que n??o requerem instala????o em um servidor pr??prio). Esta ?? uma prova de conceito que busca evidenciar as possibilidades e obst??culos associados ?? oferta deste tipo de pr??tica educativa em um contexto latino-americano.

Organização parlamentar, processo decisório e produção legislativa no cenário político capixaba : uma análise da Assembléia do Estado do Espírito Santo na 16ª legislatura (2007-2010)

Esta pesquisa é um estudo sobre o processo legislativo e a produção de leis na ALES, durante a 16ª Legislatura. O escopo do estudo foi o de analisar o impacto das regras, contidas no regimento interno e na Constituição estadual, na produção de leis entre 2007 e 2010. O pressuposto geral da abordagem advém do Novo Intitucionalismo como movimento teórico da Ciência Política contemporânea, que nos permite inferir que as regras institucionais, para além de serem simples regras de organização das Casas Legislativas, influenciam no processo decisório e, consequentemente, na produção de leis. Importando as análises dos modelos distributivo, informacional e partidário de organização dos Legislativos, a pesquisa permitiu concluir que, a ALES, de 2007 a 2010, manteve seus trabalhos alinhados à versão distributiva. O parlamentar capixaba atuou, individualmente, a fim de manter suas bases eleitorais. Com relação à atuação do sistema comissional, foi identificada a inaptidão das comissões da ALES para influenciar o processo decisório. As comissões permanentes não possuem capacidade de moldar os projetos que por elas tramitam. O regime de tramitação influencia diretamente a produção de leis da ALES, notadamente, nas leis de autoria do Executivo, já que estas, tramitaram, quase que na totalidade, em regime de urgência. No que tange aos partidos, a fragmentação partidária identificada na ALES acaba por refletir nos dados obtidos sobre a produção de leis, na medida em que não existe uma verdadeira articulação em torno dos partidos como atores determinantes no processo legislativo da ALES. Enfim, em apertada síntese, foi possível constatar a imposição da agenda de trabalhos pelo Executivo. Os projetos aprovados, de temas importantes e abrangência estadual, foram, em sua maioria, propostos pelo Executivo; a urgência impacta frontalmente os projetos do Executivo, que são aprovadas em pequeno espaço de tempo; as comissões não possuem poder mínimo de influência nos projetos de autoria do Executivo; e os partidos, altamente fragmentados, não constituem instância com capacidade de articulação.

A guerrilha esquecida : memórias do Caparaó (1966-67), o primeiro foco guerrilheiro contra a ditadura militar no Brasil

Este estudo tem como objetivo discutir a memória histórica do primeiro foco guerrilheiro no Brasil, organizado pelo Movimento Nacional Revolucionário (MNR), em 1966-1967, com o apoio de Leonel Brizola e de Cuba, na região do Caparaó, divisa dos Estados de Minas Gerais e Espírito Santo. Assim, o estudo se propõe a analisar o pouco conhecido episódio da formação, do idealismo e do desfecho que envolveu a Guerrilha do Caparaó, apresentando as memórias dos guerrilheiros (sendo em sua grande maioria ex-militares), dos agentes da repressão, dos setores conservadores da sociedade e dos habitantes das comunidades do entorno do atual Parque Nacional do Caparaó, demonstrando, assim, as diferentes percepções e representações sobre a referida Guerrilha. Para tanto, será exposto todo o contexto histórico da época em questão. Como metodologia, utilizaremos o conceito de memória, que, em suas ramificações, abrangerá a história oral, além de análises bibliográficas, pesquisas em jornais do período (A Gazeta, O Globo, Jornal do Brasil, A Última Hora, Tribuna da Imprensa, Correio da Manhã, O Estado de São Paulo, Estado de Minas, O Diário da Tarde), em revistas (O Cruzeiro, Opinião e Revista Capixaba) e em documentos da Delegacia de Ordem Política e Social (DOPS) dos Arquivos Públicos dos estados do Espírito Santo e Minas Gerais, e documentos do Serviço Nacional de Informação (SNI), do Arquivo Nacional.